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Scenario 1: Periods get heavier and cycles shorten Overview: In early perimenopause, estrogen starts rising and falling more erratically

Important safety considerations include contraindications in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, caution in those with a history of pancreatitis, increased risk of gallbladder disease, potential for acute kidney injury with dehydration, and possible worsening of diabetic retinopathy with rapid glycemic improvement

12 mg weekly (advanced/aggressive)

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Each dose increase follows the same pattern: brief adjustment, then improved appetite control

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